Camp Pendleton’s Optimal Antepartum Visit Program

Cdr. Jack Klausen

Cdr. John Holman

Antepartum Visits Goals

• Education

• Evaluation

• Documentation

• Intervention

Three types of Antepartum Visits

• Normal– Falls with in accepted standards

• Complicated– High Risk– Requires more time and effort

• Teen Pregnancy

• Singles Pregnancy

• Educational

Optimization of Staff/Facilities

• Fewer Visits at Strategic Times– Allows more Time for each visit

• 20 vs 15 minutes (midwives)

• 15 vs 10 minute (Physicians)

– Each visit accomplishes a specific goal

Optimization of Patient’s Time

• Fewer Unnecessary trips to hospital– Parking– Waiting Rooms– Missed Work– Baby Sitting– Why did I come to just get measured and

weighed?

Why the Nine Visit Protocol

• Recommended in 1989 by Expert Panel on the Content of Prenatal Care.

• Studied extensively

• Rigidly structured as to content and goals

• Supported by educational material designed for Normal Obstetrical Patients

• Allowed more time for other than normal pregnancies

Implementation

• Nine Visit Pathway Created

• Normal Pregnancy defined using Kaiser Colorado Region criteria

• Began Process at Pregnancy Registration

• Booklet Given to all patients– New Installment for next visit given at each

visit

Visit Schedule

• See Handout of Nine Visit Pathway

• Method for removing from Nine Visit to Complicated Obstetrics Clinic

Educational

• See Support Booklet– Soon Will Have in Spanish

• See Web Page

• Incorporated in our Classes

Modification of our Practice

• All patients receive an anatomical U.S. at 18 Weeks

Historical Precedence at Camp Pendleton

• All Pregnant Patients were seen on basically the same schedule – Averaged 15 Visits per Patient with no definable

complication

• No real structure as to when patient was seen in pregnancy only how far apart the visits were

• No structures as to what was done and taught at each visit

Historical Precedence Cont’d

• Comments on Form 600 were about random findings

• Patients complained that they were not getting the information they needed

• Complicated Obstetrics was not handled in a structured manner

• Different approaches to care between Family Practice and Obstetrical Clinics

Under New System

• Each Visit is Structured as to content and education

• Patient knows ahead of time what to expect from the visit– Can Formulate Questions from handout from

previous visit

• Corpsman and Nurses can participate in Education Process

New System Continued

• Allows better separation of Patients between MD and Nurse Providers

• Allows Complicated Obstetrics to be seen in a formal context with cases discussed amongst providers

• Soon will help integrate with our visiting MFM Staff

• Assist resident Teaching

Advantage to date

• We have adequate Obstetrical Appointments for both Complicated and Normal OB

• Our Performance in the Navy Wide Patient satisfaction survey has improved.

• The Provider Staff find the Normal Obstetrical Clinic Functions for more efficiently

Further Advantages

• Patient Satisfaction is improved as evidenced by survey and postpartum questions

• Unnecessary Ultrasounds have been markedly reduced– Patient has fewer opportunities to request them

Patient Care

• We have been doing the 9 visit protocol for 7 months and there has been no evidence of any adverse effects– This was also the case in the Kaiser Studies

• Rarely a patient will state that she was used to more visits with previous pregnancies– Explain reasoning to patient– Allow them extra visits

Plans

• One Year Out to survey patients as their satisfaction

• One Year Out to review our statistics for pregnancy complications to compare outcome

• DEVELOP AN ANTEPARTUM DOCUMENTATION SHEET – Separate Normal and Complicated Patients